ABSTRACT
Parkinson disease (PD) is a movement disorder characterized clinically by the variable combination of rigidity, bradykinesia, rest tremor and postural instability. Usually postural instability is a late-onset manifestation and is frequently associated with axial manifestations and with a poor prognosis. We report a 67-year-old female with orthostatic tremor as the etiology of her postural instability. The patient was treated with increasing doses of clonazepam, reaching 2 mg/day, and levodopa. There was an improvement of postural instability with a good response of parkinsonian symptoms.
Subject(s)
Aged , Female , Humans , Parkinson Disease/complications , Postural Balance/physiology , Sensation Disorders/diagnosis , Tremor/diagnosis , Electrophysiological Phenomena , Sensation Disorders/etiology , Tremor/complicationsABSTRACT
Parkinson disease (PD) is a movement disorder characterized clinically by the variable combination of rigidity, bradykinesia, rest tremor and postural instability. Usually postural instability is a late-onset manifestation and is frequently associated with axial manifestations and with a poor prognosis. We report a 67-year-old female with orthostatic tremor as the etiology of her postural instability. The patient was treated with increasing doses of clonazepam, reaching 2 mg/day, and levodopa. There was an improvement of postural instability with a good response of parkinsonian symptoms.
Subject(s)
Parkinson Disease/complications , Postural Balance/physiology , Sensation Disorders/diagnosis , Tremor/diagnosis , Aged , Electrophysiological Phenomena , Female , Humans , Sensation Disorders/etiology , Tremor/complicationsABSTRACT
Pure Autonomic Failure is a progressive, adult onset, degenerative disorder of the autonomic nervous system characterized clinically by orthostatic hypotension, bladder, sexual and sudomotor dysfunction. Since there are no other associated somatic neurological deficits, this condition must be considered in the differential diagnosis of orthostatic hypotension. We report a 64 years old man with a history of seven years of autonomic dysfunction, with severe orthostatic hypotension, erectile and bladder dysfunction. Autonomic tests showed low circulating norepinephrine levels, sweating abnormalities with regional anhydrosis of the left side of the trunk and abnormal cardiovagal response, indicating generalized autonomic failure. Peripheral somatic neuropathies with autonomic involvement were excluded by normal electrophysiologic tests and the patient was diagnosed pure autonomic failure. Treatment with fludrocortisone and midodrine improved orthostatic tolerance.
Subject(s)
Autonomic Nervous System Diseases/diagnosis , Hypotension, Orthostatic/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged , Respiration , Sweating , SyndromeABSTRACT
The aim of this study was to determine whether the sympathetic skin response (SSR) recorded from the big toe is more sensitive than standard SSR recorded from the sole for the detection of sudomotor fiber dysfunction in diabetic neuropathy. We recorded big toe SSR (SSRBT) and plantar SSR (SSRP) in 17 diabetic patients with non-disabling neuropathy (group A), 13 patients with disabling neuropathy (group B) and 30 age-matched normal controls. With regard to controls, SSRP amplitude was reduced only in group B. In contrast, SSRBT amplitude was reduced in both groups of patients (p<0.0001). In 8 patients in group B, SSRBT was not recordable while the SSRP still persisted. Our results suggest that SS-RBT is a more sensitive test than SSRP in detecting distal sudomotor failure in patients with diabetic neuropathy.
